What is aortic dissection?

An aortic dissection, although uncommon, begins with a tear in the inner layer of the aortic wall of the thoracic aorta. The aortic wall is made up of three layers of tissue. When a tear occurs in the innermost layer of the aortic wall, blood is then channeled into the wall of the aorta separating the layers of tissues. This generates a weakening in the aortic wall with a potential for rupture. Aortic dissection can be a life-threatening emergency. 

What causes aortic dissection?

The cause of aortic dissection is still under investigation. However, there are several risk factors associated with aortic dissection, such as:

• Hypertension (high blood pressure)
• Connective tissue disorders, such as Marfan's disease, Ehlers-Danlos syndrome, and Turner's syndrome
• Cystic medial disease (a degenerative disease of the aortic wall)
• Aortitis (inflammation of the aorta)
• Atherosclerosis
• Existing thoracic aneurysm
• Bicuspid aortic valve. Presence of only two cusps, or leaflets, in the aortic valve, rather than the normal three cusps
• Trauma
• Coarctation of the aorta (narrowing of the aorta)
• Hypervolemia (excess fluid or volume in the circulation)
• Polycystic kidney disease (a genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys)

What are the symptoms of aortic dissection?

The most commonly reported symptom of an acute aortic dissection is severe, constant chest and/or upper back pain, sometimes described as "ripping" or "tearing." The pain may be "migratory," moving from one place to another, according to the direction and extent of the dissection. 

How is aortic dissection diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for an aneurysm may include any, or a combination, of the following:

• Computed tomography scan (also called a CT or CAT scan

• Transesophageal echocardiogram (TEE).

The doctor will determine the most appropriate examination. When a diagnosis of aortic dissection is confirmed, immediate intervention, such as surgery, is usually performed.

Depending on the location of the dissection, the treatment options vary:

• Medication. Used to control factors such as high blood pressure
• Surgery:

Open Aortic Dissection repair. For an ascending or aortic arch dissection, a large incision may be made through the breastbone (median sternotomy). The dissection involves damage to the aortic valve of the heart, the valve may be repaired or replaced during the procedure.). These approaches allow the surgeon to visualize the aorta directly to repair the dissection.

Endovascular repair.  This is a procedure which requires only small incisions in the groin, along with the use of X-ray guidance and specially-designed instruments, to repair the dissection by inserting a tube, called a stent-graft, inside the aorta. Not all dissections can be repaired using endovascular techniques.